RESEARCH: Decreasing Pain in Submuscular Breast Augmentation Surgery

Posted on March 14, 2019 under Breast Augmentation, Breast Implants

By Dean Jabs, MD, PhD; Bryson G. Richards, MD; and Franklin D. Richards, MD


In submuscular breast augmentation, the muscle is transected along its inferior and medial border to allow the implant to rest beneath the breast mound and supply adequate cleavage. This leads to significant pain in the postoperative period. Objective: This study was undertaken to quantitatively document the effectiveness of tumescent infiltration and bupivicaine with epinephrine injection in controlling postoperative pain in primary submuscular breast augmentation and its effect on operating time, narcotic use, and complications.


A retrospective chart review of 150 primary submuscular augmentation mammaplasties performed by 2 surgeons was conducted. Seventy-five consecutive augmentations performed by each physician during the same time period were studied. One surgeon used tumescent infiltration, using a syringe and a blunt infiltration cannula, placing 50 mL of standard tumescent solution in the planned pocket area of each breast before dissection. In addition, all cut muscle ends were injected with 0.25% bupivicaine with epinephrine (1:100,000, 40 mL per patient) under direct vision. The other surgeon omitted these steps. Patients evaluated pain subjectively using a 0 to 10 numeric pain intensity scale reported to the recovery room staff at specific times in the postanesthesia care unit.

Click here to download the full report and see the results

pain level


If you would like to learn more about plastic surgery procedures performed by Plastic Surgeons Franklin D. Richards, M.D. , A. Dean Jabs, M.D.  and Dr. Keshav Magge please visit or Serving patients in and around Northern Virginia, Maryland, Washington DC, McLean, Bethesda, Fairfax County, Rockville, Alexandria, Chevy Chase an, Potomac, Montgomery County, and Londoun County.

Contact Us